Hepatocellular carcinoma (HCC) is a complex and heterogeneous tumor with various genomic alterations.In most patients,HCC is associated with cirrhosis which contributes to treatment morbidity and mortality.Cirrhosis adds difficulties to clinical management of HCC.Over the past decade,several molecular targets which are involved in the etiology of HCC have been identified.Among them,treatment with sorafenib,an antiangiogenic and Raf kinase inhibitor,has shown survival benefit.This represents a breakthrough in treatment of this complex disease,and proves that molecular therapies can be effective in HCC.It is becoming apparent that to overcome the complexity of genomic aberrations in HCC,combination therapies are essential.Several ongoing clinical trials show encouraging results.Future researches are necessary to identify new compounds to block important undruggable pathways,and to identify new oncogenes as targets for therapies through novel high throughout technologies.Ultimately,a molecular classification of HCC based on genome investigations and identification of patient subclasses using drug responsiveness will lead to a more personalized treatment.Although molecular therapy is a promising treatment for HCC with cirrhosis,surgery,if applicable,remains the first choice of treatment.

Situs inversus is a rare condition of anatomical alteration, and the patient with gallbladder disease treated by laparospic cholecystectomy is rather scarce. In this condition, the operation needs to be adjusted. In this article, we reviewed the relevant literatures about the operation in the patients with this uncommon malformation and analyzed the modification of the operation.

Objective　To investigate the possible causes for asymptomatic process of hepatic artery thrombosis in the patients following orthotopic liver transplantation (OLT). Methods　Hepatic functional tests, color Doppler ultrasonic observation, hepatic arteriographic examinations were done during the course of the development of the hepatic arteriothrombosis. All possible factors leading to the asymptomatic process were comprehensively analyzed. Results　At the 4th postoperative day, thrombosis started to form along the anastomosis line. At the 21st postoperative day, the artery became completely thromboses. During this course, serial liver biopsy revealed introhepatic cholestasis, hydropic degeneration of hepatocytes, atrophy of the biliary epithelium and fibrosis in the portal area. Serial monitoring of liver function gradually revealed normal with the exception of elevation of r-GT and ALP. At the 71st day after OLT, arteriography showed that hepatic artery remained completely occluded, while the collateral circulation and compensatory expansion of the portal vein were established. The patient didn't have any symptoms of arterial thrombosis. Conclusions　In this case, it was the collateral circulation and the compensation of the portal vein that made the allograft survive and helped to prevent the patient from retransplantation after hepatic artery thrombosis. Color Doppler ultrasonic examinations within 2 weeks following OLT were helpful to the early diagnosis of hepatic arteriothrombosis.

Objective To evaluate the treatment and prevention measure for intrahepatie diffuse biliary stricture after orthotopic liver transplantation. Methods The clinical data of 21 patients with intrahepatic diffuse biliary stricture after orthotopic liver transplantation from January 2002 to December 2007 in Beijing Center for Organ Transplantation were retrospectively analyzed. A prospective clinic study was launched in order to prevent microthrombosis in the microcireulation of bile duct during warm and cold iscbemia in non-heart-beating donor since January 2006. Urokinase perfusion of the artery system was conducted during graft harvesting and reperfusion at the end of graft trimming to reduce the incidence of intrahepatic diffuse biliary stricture. Results Among 21 patients with intrahepatie diffuse and mixed type biliary stricture, 16 patients underwent liver retransplantation, and the other 5 patients died of primary graft failure while waiting for retransplantation. The incidence of intrahepatic diffuse biiiary stricture was 5.9% in non-urokinase perfusion group. On the contrary, the incidence rate of intrahepatie diffuse biliary stricture was 1.4% in urokinase perfusian group (x2 = 5.98, P < 0. 05). Conclusions Liver retransplantation is effective for refractory biliary stricture in liver transplant recipients. The incidence of intrahepatic diffuse biliary stricture is reduced in non-heart-beating donor by using urokinase perfusian.

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. In ad-dition to genetic alterations, epigenetic inactivation of (tumor suppressor) genes has been recognized as an important and alternative mechanism in tumorigenesis. In recent years, increasing evidence has shown that ep-igenetic silencing of those genes is essential to carcinogenesis and metastasis. Epigenetics include two main forms: histone acetylation and DNA methylation, histone acetylation and DNA hypomethylation can promote gene expression,otherwise, they will inhibit gene expression. It is important to the methylation especially the hypermethylation of the tumor suppressor gene during the hepatocarcinogencsis. The study of epigenetics will be proved valuable for early diagnosis and disease monitoring at hepatocell.

Objective To reconstruct the three-dimensional images of normal liver using 256-slice intelligent CT (iCT)and to measure the volume of liver and its segments.Methods 48 healthy adults underwent abdominal contrast enhancement iCT,and the images in portal venous phase were transmitted to a workstation (EBW4.5)to obtain the three-dimensional images of the liver.The total liver volume was measured,and a scatter plot was gotten between body surface area and liver volume.According to the Couinaud classification of hepatic segment ofⅠ-Ⅷ,the volume of each segment was also measured.Results The mean total liver volume in 48 adults was (1 343.2±238.3)mL,which was positively correlated with body surface area with a correlation coefficient of 0.87 and a regression equation of LV(mL)=763.0×BSA-28.6.The volume of SegmentⅠ-Ⅷ was(24.5±4.3)mL,(148.6±31.6)mL,(110.4±24.9)mL, (222.3±43.0)mL,(212.8±36.5)mL,(186.7±34.7)mL,(164.3±30.8)mL and (273.4±56.1)mL,and their percentage was (1.8±0.2)%,(11.0±1.1)%,(8.2±1.1)%,(16.6±1.4)%,(15.9±1.0)%,(13.0±1.0)%,(12.2±0.7)% and (20.3±1.5)% respec-tively.Conclusion The three-dimensional images of liver and hepatic segments can be well reconstructed by 256 slice iCT.

Objective To explore the causes and treatment measures of hyponatremia after liver transplantation. Methods The clinical data of 27 patients with hyponatremia after liver transplantation were analyzed retrospectively. Results Among the 27 patients, postoperative hyponatremia occurred in 25 cases in about one week, and preoperative hyponatremia occurred in 2 cases and severe ~hyponatre -mia occurred immediate after operation. Acute hyponatremia occurred in one case. Blood natrium was 130 to 135 mmol/L in 10 cases, 120 to 130 mmol/L in 12 cases and less than 120 mmol/L in 5 cases. The levels of blood potassium, phosphor and calcium were all normal. Urinary natrium, potassium and chlorine levels were all normal. The ascites natrium level was higher than blood natrium at the same time. Hyponatremia was treated by supply of hypertonic saline via gastrointestine an/or veins. Conclusion Various causes could result in hyponatremia after liver transplantation. The hyponatremia was treated by supply of hypertonic saline constantly and slowly.

Objective To summarize the experience of emergency orthotopic liver transplantation (EOLT) in fulminant hepatic failure (FHF).Methods The clinical date of 4 cases of FHF successfully subject to EOLT were retrospectively analyzed.Results Four patients’ consciousness completely recovered in 12 to 48 h after operation, no surgical complication occurred; Acute rejection postoperatively occurred in 2 patients and reversed after treatment. Now 4 patients were survived for 38, 17, 11, 7 months respectively with good liver function, and 3 of them went to work again.Conclusion EOLT is an effective means to cure FHF. Choosing appropriate perioperative management and (operative) timing is essential to improve the successful rate of EOLT.

OBJECTIVE To analyze the characteristic of vancomycin-resistant Enterococcus(VRE) infection after orthotopic liver transplantation, and provide a basis to improve prophylaxis and therapy. METHODS A retrospective survey in 136 patients who underwent orthotopic liver transplantation was carried out to define the incidence, clinical feature and therapeutic outcome of VRE infection. RESULTS Eleven patients were infected by VRE in this study and the incidence of infection by VRE was 8.1% following liver transplantation. Totally 31 of the VRE isolates were isolated, including 26 Enterococcus faecium strains and 5 E. faecalis strains. Sites of VRE infection included abdomen(n=4), blood(n=2), and respiratory tract(n=2). In the other 3 patients, VRE was cultured from multiple sites. Among 11 patients with VRE infection, 4 were sensitive to teicoplanin, and 7 resistant to teicoplanin. So 4 patients received antibiotics with teicoplanin and 7 patients with linezolid. In this study, 10 patients were cured and 1 patient died of sepsis. CONCLUSIONS VRE has become an nosocomial pathogen of increasing importance in liver transplantation patients. The risk factor of VRE infection should be paid attention. Infection prophylaxis of VRE should be emphasized.

Objective To study the anatomy of the thoracic outlet and inlet,and to evaluate the CT diagnosis and differential diagnosis on abnormal conditions.Methods CT images of 117 pathologically and clinically proved cases in the zones were analyzed retrospectively.Control group contained 50 normal volunteers who were divided into 5 anatomic regions: region 1 (thyroid zone),region 2 (interior thyroid),region 3 (lateral thyroid),region 4 (posterior thyroid),and region 5 (anterior thyroid).Results Of the 117 cases,there were 11 cases (9.40%) in region 1,8 cases (6.84%) in region 2,72 cases (61.54%) in region 3,1 case (0.85%) in region 4,3 cases (2.56%) in region 5,15 cases (12.8%) in transregions (region 1,3,5),and 7 cases (5.98%) in transregions (region 1,2,3).The disorders were mainly distributed in region 3,in which lymphatic node abnormalities were the most common (55 cases).The 32 cases of abnormal thyroid gland were mainly located in region 1 and involved with other regions.Conclusion The 5 regions divided on CT anatomy of the thoracic outlet and inlet are very useful for the localization and definition in the diagnosis,which have important clinical value.