Perihilar surgery is full of challenge,risk,variability and uncertainty.Because of the anatomic variability,the pathophysiological complexity and invasion of the diseases,hepatic hilar biliary surgery has the characteristics of high operative difficulties,low resection rate,easy intraoperative bleeding,more postoperative complications,high recurrence rate and mortality rate.The cure rate and safety of the operation can be improved only through comprehensive imaging examinations and preoperative evaluation of liver function as well as the correct use of surgical techniques of anatomic paths,lesions excision and hepatic hilar reconstruction.The core of perihilar surgical techniques is hepatic hilar anatomy and explosion,including hilar plate dissection,dissection of liver along the medial fissure,quadrate lobe of liver resection and perihilar resection.Perihilar surgery is a comprehensive technique involving preoperative,intraoperative and postoperative procedures.The cure rates of perihilar biliary diseases can be improved by a combination of enhanced recovery after surgery and optimized and individualized surgical plans for patients.

Objective To explore the predictive value of plasma catestatin (CST ) and its influence factors for prognosis of patients with chronic systolic heart failure .Methods In a retrospective study ,the clinical data of 352 chronic systolic heart failure patients were collected from our hospital 2009 to 2013 .The patients were categorized into 4 groups (n= 88) according to CST (ng/L) quartile :≤ 60 .24 ,60 .25 - 76 .57 ,76 .58 - 86 .33 and ≥ 86 .34 ng/L .Blood pressure ,heart function ,blood biochemical index and renal function were compared among groups as well as the correlation with CST by Spearman correlation .According to the survival situation of follow‐up ,the patients were assigned into death and survival groups .The predictive value of CST for the prognosis of chronic systolic heart failure patients were analyzed by univariate and multivariate Cox survival analysis .Results Age ,sex ,body mass index ,red blood cell count ,red blood cell volume ,hemoglobin ,albumin ,total bilirubin ,serum creatinine ,blood urea nitrogen ,u‐ric acid and pathogeny among 4 groups had no statistical significance (P> 0 .05) .Patients with higher CST levels were more likely to had higher NYHA classification ,systolic pressure ,diastolic pressure ,high sensitivity C‐reactive protein (hs‐CRP) ,plasma N‐ter‐minal proBNP (NT‐proBNP ) ,left ventricular end‐diastolic diameter (LVEDD ) and right ventricular end‐diastolic diameter (RVEDD) ,and had a lower left ventricular ejection fraction (LVEF) (all P< 0 .05) .The CST was positively correlated with hs‐CRP ,NT‐proBNP ,LVEDD and RVEDD (r = 0 .452 ,0 .571 ,0 .536 ,0 .473) and negatively correlated with LVEF (r = - 0 .357) . Taken CST ≤ 60 .24 ng/L for reference ,the risks of death for groups of 60 .25 - 76 .57 ,76 .58 - 86 .33 and ≥ 86 .34 ng/L increased by 1 .471 ,1 .767 and 7 .822 ,respectively .The Cox survival analysis showed that NYHA classification ,LVEF ,cardiac arrhythmia , atrial enlargement ,heart failure history and CST were independent prognostic factors .Conclusion The mortality of patients with chronic systolic heart failure was associated with plasma CST .Elevated CST increased total mortality risk and were independent prognostic factors of these patients ,but the evaluation of the prognostic value of CST etiology factors should be considered .

Recently studies indicated that some lymphomas accompanied with follicles prove to be T cell lymphomas by gene rearrangement detection. So the advances about pathogenesis, clinical and pathohistology characters of T zone lymphomas are reviewed based on the correlated literatures.

Objective To apply 12-leads HOLTER monitoring and analysis to observe paroxysmal atrial fibrillation (PAF) and its related atrial arrhythmias so as to explore the triggering factors of PAF. Methods 47 patients with PAF, including 20 male patients and 27 female patients, were given 12-HOLTER monitoring and analysis. Their average age was 64.89 ±12.70 years-old.PAF patients were subdivided into 2 subgroups: the triggered PAF subgroup and the untriggered PAF subgroup. Patients with atrial premature beats but without PAF were selected into the control group. The PAF and its related atrial arrhythmias were detected and analyzed by 12-HOLTER.Results (1) 9 events of PAF were found in 47 patients by 12-HOLTER monitoring and analysis, among them 72 events of PAF were triggered by atrial premature (AP) (91.1%, 72/79), 6 events of PAF occurred automatically and suddenly (7.6%, 6/79);and only 1 events of PAF was triggered by atrial flutter (1.3%,1/79) . (2) The coupling interval of AP in the triggered PAF subgroup was significantly shorter than that of the untriggered PAF subgroup and control group (490 ±90ms vs. 590 ±140 ms and 630 ±90ms, <0.05);The index of AP was smaller significantly in the PAF group than that of the untriggered PAF subgroup and controll group (0.52±0.12 vs. 0.62±0.09 and 0.71±0.06, <0.05);TheP' on Tof AP was significantly higher in the PAF group than that of the untriggered PAF subgroup and control group (84.72%vs. 26.73%and 2.78%, <0.017);The interval before the AP in PAF group was prolonged more significantly than that of controlled group (990±280 ms vs. 940±210 ms, <0.05) . (3) During 2 min~30 s before the PAF occurrence control as total times,the AP appeared more frequently (from 0.43 beats/min to 3.5~6.00 beats/min, <0.017) . (4) Most of the AP which triggered PAF was originated from the upper part of the left atrium (61/72,84.7%) .Conclusions Most events of PAF are triggered by AP, the AP which can trigger PAF may be of some of the features such as a shorter coupling interval,a smaller AP index,P' on Tand a longer interval before the AP,PAF more occurrence while the AP may take place more frequently.Most of the AP which triggered PAF are originated from the upper part of left atrium.

Objective To assess the curative effects of simvastatin combine with low molecular weight heparin in patient with unstable angina.Methods The papers from China Academic Journal ( CNKI),Chongqing VIP (VIP),PubMed database were retrieved by computer,15 randomized controlled trials( 1206 patients) were included for Meta-analysis.ResultsThe overall efficiency of the two groups were compared by Fixed effects model:x2 =2.62,Consolidated RR =1.30 (95％ CI:1.23 ～ 1.38 ) ; the number of attacks after treatment of the two groups were compared by random effects model:x2 =1231.87,WMD =- 2.68 ( - 5.82,0.5 ) ; the duration time of attacks after treatment in both groups were compared by random effects model:x2 =1231.87,weighted mean difference =-2.68(-5.82,0.5).Conclusion Simvastatin combine with low molecular weight heparin could improve the overall efficiency on patient with unstable angina,and could not reduce the number of attacks after treatment,but could reduce the duration time of attacks after the treatment.

Objective To explore the efficacy of oppression hemostsis time on hemorrhage and patient comfort after carotid endarterectomy. Methods Patients with carotid artery stenosis from January 2014 to September 2015 were enrolled.The patients were divided into three groups according to oppression hemostasis time:control group for 24 hours,experimental group one for 12 hours,experimental group two for 6 hours.The outcomes were the incidence of hematoma,errhvsis,anxiety,and neck pain. Results No significant differences were observed in hematoma and errhysis among these three groups.The total scores of anxiety and neck pain of experimental group two were (51.43±8.18) points,(1.28±1.06) points,obviously surpassed the comparison group (56.64 ± 7.08) points,(2.31 ± 1.17) points,showed a significant decrease in two groups (t=2.96, 4.03, P<0.05). The total scores of anxiety and neck pain of experimental group one were (54.14±8.99) points,(1.97±0.97)points,showed no significant in compared with comparison groups(t=1.31, 1.32, P>0.05). Conclusions The preferred option for oppression hemostasis time is 6 hours that has an effective hemostasis with a favorable patient comfort.

To evaluate the effectiveness of applying visual electrophysiological examination, including flash visual evoked potentials ( FVEP ) , flash electroretinogram ( FERG ) , pattrn electroretinogram ( PERG ) , fundus photography, eye B-type ultrasound, optical coherence tomography ( OCT ) , on visual function assessment and retinal disease detection before cataract surgery. METHODS: Visual elctrophysiological examination, fundus photography, eye B-type ultrasound and OCT were applied in 148 cases ( 196 eyes ) . The positive rate was analyzed according to the results of FVEP, FERG ( or PERG ) , fundus photography, eye B - type ultrasound and OCT.RESULTS: ln 148 cases ( 196 eyes ) , vitreous opacities was showed in 165 eyes ( 84. 2%) by eye B - type ultrasound examination, 31 eyes (15. 8%) without access to B-type ultrasound image; success for fundus camera images in 161 eyes (80. 6%), and unable to get image in 35 eyes (19. 4%); the VEP and ERG in 58 eyes (29. 6%) were get valuable, and the VEP and ERG were saw no obvious abnormal in 138 eyes ( 70. 4%); success for OCT image in 167 eyes (85. 2%), without access to OCT image in 29 eyes (14. 8%). CONCLUSlON: Visual elctrophysiological detection, fundus photography, eye B-type ultrasound and OCT can predict the preoperative visual acuity of cataractous patients. A variety of inspection methods complement each other, can further improve detection rate of retinal diseases and other eye disease before cataract surgery.

Objective To study the relationship between bronchial asthma and tuberculin reaction.Methods The concentractions of serum IgE,IFN-? were determined by ELISA,then obtained data was compared with results of tuberculin reaction.Results ⑴Tuberculin reaction of the patients with asthma almost all showed negative,however the patients with tuberculin showed positive,even strong positive.⑵As compared patients with tuberculi reaction negative,the concentration of serum IgE in tuberculin reaction positive patients was lower,but the concentration of serum IFN-? was higher.Conclusions The Th1 cells immune function is reduced in the bronchial asthma patients,but elevation of Th2 cells immune function.

3cm than in the patients with the largerest dominant diameter≤3cm.Embolization with combination of PLE and GSP had improved the percentage of reduc- tion in myomas volume.Conclusion The factors affecting results include tumor size and location,using of GSP,and performing of bilateral embolization.

To discuss the relativity of chronic cough and postnasal drip syndrome(PNDS) for better clinical diagnosis and treatment.